Abstract
BackgroundCoincident with the advent of mammography screening, breast carcinoma in situ has increased in the US population.MethodsWe conducted a prospective cohort study of all women presenting with primary breast cancer, aged 21–94, and biopsy confirmed Stage 0-IV from 1990–2005 identified and tracked by our registry. Clinical presentation characteristics including age, race, TNM stage, family and pregnancy history, histologic type and method of detection by patient (PtD), physician (PhysD) or mammography (MgD) were chart abstracted at time of diagnosis. Cases with unknown or other method of detection (n = 84), or unusual cell types (n = 26) were removed (n = 6074).ResultsFrom 1990 to 1998 the percentage of PtD and MgD cases was roughly equivalent. In 1999 the percentage of MgD cases increased to 56% and PtD dropped to 37%, a significant 20% differential, constant to 2005 (Pearson chi square = 120.99, p < .001). Overall, percent TNM stage 0 (breast carcinoma in situ) cases increased after 1990, percent stage I and III cases declined, and stage II and IV cases remained constant (Pearson chi square = 218.36, p < .001). Increase in MgD over time differed by age group with an 8.5% increase among women age 40–49 and 12% increase among women age 50–95. Women age 21–39 rarely had MgD BC. In forward stepwise logistic regression modeling, significant predictors of MgD BC by order of entry were TNM stage, age at diagnosis, diagnosis year, and race (chi square = 1867.56, p < .001).ConclusionIn our cohort the relative proportion of mammography detected breast cancer increased over time with a higher increase among women age 50+ and an increase of breast carcinoma in situ exclusively among MgD cases. The increase among women currently targeted by mammography screening programs (age ≥ 50) combined with an increase of breast carcinoma in situ most often detected by mammography screening indicates a possible incidence shift to lower stage breast cancer as a result of mammographic detection.
Highlights
Coincident with the advent of mammography screening, breast carcinoma in situ has increased in the US population
Mammography techniques for identification of breast cancer were first developed in the 1960s, the results of mammography screening programs were first published in the 1970s, and recommended screening guidelines were developed in the 1980s [2,3,4,5]
Our study aims to identify changes and trends in mammography detected breast cancer over time by reviewing primary breast cancer presentation characteristics at a population based comprehensive community cancer care center in a major urban area which is part of the SeattlePuget Sound Surveillance Epidemiology and End Results (SEER) cancer registry program of the National Cancer Institute [16]
Summary
Coincident with the advent of mammography screening, breast carcinoma in situ has increased in the US population. Mammography techniques for identification of breast cancer were first developed in the 1960s, the results of mammography screening programs were first published in the 1970s, and recommended screening guidelines were developed in the 1980s [2,3,4,5]. In spite of strong scientific evidence supporting the value of mammography screening, a budget cut to the National Breast Cancer and Cervical Cancer Early Detection Program was proposed in 2006 [9]. Self breast exam and clinical breast exam have both been questioned as viable screening methods with changing recommendations for their use as screening tools over the past 15 years [13,14,15]
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